Shock can have many different meanings. A movie’s plot twist could be shocking to some. Touching a live wire could result in a shock. You may be in shock as a result of the death of a loved one or as a result of trauma. Shock, in my opinion, is a terrifying term that predicts poor outcomes despite our best medical efforts.
Despite the best medical care in the best hospitals, mortality rates can range from 40% to 50%.
What will you do if your partner or family member is involved in an accident or suffers a heart attack and goes into shock?
The most important aspect of treating shock is learning to recognize it as soon as possible. The earlier the diagnosis, the sooner the treatment can begin.
What is shock?
To begin, shock is defined as a lack of blood and oxygen supply to the tissues. Tissues and cells starve as a result of a lack of these nutrients. When this happens, the tissues and organs stop working.
The greater the number of organ failures, the higher the mortality rate. The sooner the cells’ nutrients and function are restored, the better their chances of survival.
In order to minimize cell damage, the body has several mechanisms in place to compensate for the lack of tissue perfusion.
Although many organ systems are involved in compensatory mechanisms, the cardiovascular system is the process’s foundation.
A pump (the heart), pipes (the blood vessels), and fluid are required for the cardiovascular system to maintain its pressure in a closed loop (the blood).
In order to minimize cell damage, the body has several mechanisms in place to compensate for the lack of tissue perfusion. Even though many organ systems are involved in compensatory mechanisms, the cardiovascular system is the process’s foundation.
A pump (the heart), pipes (the blood vessels), and fluid are required for the cardiovascular system to maintain somewhat constant pressure in a closed loop (the blood). If any of these components fail, there is a loss of pressure in the system.
If the pressure loss is severe, the tissues and organs will not be nourished with the necessary components for proper organ and body function. Let’s dig a little deeper into this.
The pump output (cardiac output) and systemic vascular resistance control the pressure in the system (changes in vessel diameter or changes in blood viscosity).
The heart rate and stroke volume determine cardiac output (how much blood is pumped with each contraction of the heart). The formula is as follows:
Mean Arterial Pressure (MAP) = Cardiac Output (CO) x Systemic Vascular Resistance (SVR)
Cardiac Output = Heart Rate (HR) x Stroke Volume (SV) Therefore, MAP = (HR x SV) x SVR
To increase systemic pressure, we must either increase heart rate, stroke volume, or systemic vascular resistance (or some combination of the three). When one of these components fails as a result of an injury or disease, the other two attempt to compensate.
This equation is critical for understanding what is happening physiologically to a person in shock.
With that in mind, the shock symptoms should make sense. Hypotension or low blood pressure is very common. Excessive fatigue, dizziness when standing, or faintness may occur.
Low blood pressure causes the body to divert blood away from less important organs, such as the skin. You will notice that the skin turns pale and cold.
The heart rate increases in an attempt to compensate for the low blood pressure. This causes the blood to circulate faster throughout the system in order to utilize the remaining oxygen.
The respiratory rate increases in order to bring more oxygen into the system and to mitigate the effects of increased acid buildup caused by a lack of tissue perfusion.
Due to a lack of blood or oxygen to the brain, a person may become disoriented or confused.
The stages of shock
The entire process can progress quickly and is divided into three stages.
The initial, or pre-shock, stage is the first stage. This is the point at which the person sustains an injury.
Blood is lost through a wound in an example of trauma. This is essentially a decrease in stroke volume from the previous equation. This, in turn, reduces cardiac output.
The body will try to compensate by increasing the heart rate and systemic vascular resistance (via vasoconstriction). This mechanism attempts to control bleeding by diverting blood away from less important tissues.
The body will continue to minimize the damage in the second stage (also known as compensatory stage). If you act quickly, this stage is reversible, and it is possible to save tissue and organs.
Because of the decreased cardiac output, the body activates the sympathetic nervous system, and hormones such as epinephrine are released to help increase the contractility of the heart.
The progressive stage occurs when the body fails to compensate. The tissues suffer increased ischemic damage, and lactic acid accumulates in the bloodstream.
The further this stage progresses, the more likely it becomes irreversible, and organs fail. Urine output initially decreases as the body attempts to retain as much volume as possible.
Urine production eventually ceases due to the death of kidney cells. When the liver fails, the coagulation cascade is disrupted, making it easier to bleed. Death becomes imminent.
So, with the effects of shock outlined above, let’s look at how various causes of shock affect that physiology. Shock is classified into two types: differentiated and undifferentiated.
When someone is in shock, we often say it’s undifferentiated because the patient shows signs of shock, but we don’t know what’s causing it. We begin treatment protocols right away because time is of the essence.
When we know what caused the shock (differentiated shock), we divide it into four categories: distributive, cardiogenic, hypovolemic, and obstructive.
Distributive shock
According to the equation we listed above, distributive shock occurs when systemic vascular resistance decreases and blood vessels dilate. The body responds by increasing the heart rate.
We divide distributive shock into septic and non-septic causes. Sepsis is a result of the body’s immune response to infection. Pneumonia, urinary tract infections, and even skin infections are common sources of infection.
The mortality rate with hospital treatment is approximately 40%. The initial insult determines mortality in non-septic causes of distributive shock.
Non-septic distributive shock is classified into four types: inflammatory, neurogenic, anaphylactic, and “other.” The inflammatory component could also be a component of sepsis, or it could be linked to a severe burn, trauma, or heart attack.
Neurogenic shock is typically caused by a spinal cord or traumatic brain injury. The autonomic nervous system is disrupted, resulting in reduced systemic vascular resistance and unopposed vagal tone.
Because of these changes, the hallmark of neurogenic shock is typically a slow heart rate, making it difficult for the body to compensate.
Food allergies, environmental allergies, medication allergies, and idiopathic causes can all result in anaphylactic shock. At the onset of anaphylaxis, injectable epinephrine is critical for survival.
Venomous stings (e.g., bees, scorpions, and snakes) are frequently classified as “other.”
Carbon monoxide, myxedema (due to severe hypothyroidism), and narcotics are also included in this category because of their effect on systemic vascular resistance.
Most of the causes of distributive shock could be avoided or prepared for in a survival situation prior to the irreversible portion of shock.
Keeping antibiotics on hand and wounds clean can help to reduce the risk of infection. At the first sign of infection, you could also try eating garlic or onion. However, once you’re well into the pre-shock stage, this will have no effect.
To help keep a wound clean, you could also try Echinacea, apple cider vinegar, hydrogen peroxide, or turmeric. Remember, these are very early interventions. The availability of readily available epinephrine for anaphylaxis is a no-brainer, especially if you are aware that you have such reactions.
If you have a thyroid disorder, make sure you have enough medication. Chronic steroid users must also take care not to run out of these medications, or they risk adrenal insufficiency, shock, and death.
Hypovolemic shock
This happens when there is a loss of fluid and, as a result, a decrease in stroke volume. To keep blood pressure stable, the heart rate increases to keep cardiac output stable, and the arteries constrict to keep systemic vascular resistance stable.
Hypovolemic shock is classified into two types: hemorrhagic and non-hemorrhagic.
In hemorrhagic shock, the vascular system is disrupted, resulting in a leak. While severe external bleeding can easily identify this, keep in mind that internal hemorrhage may not be as obvious.
This could be due to blunt force trauma causing a rupture in an organ like the spleen or a tear in a major vessel from a car accident.
Pelvic fractures are also associated with internal bleeding. As potential indicators of hemorrhage, look for bruising on the abdomen or flank, as well as abdominal distention.
When there is evidence of internal bleeding or shock, stabilizing a pelvic fracture at the scene can help slow the hemorrhage. You could use a sheet, a blanket, or the SAM Pelvic Sling.
Remember that people taking any type of blood thinner, including aspirin, are more likely to experience severe bleeding.
Other treatments include applying pressure to obvious sources of bleeding to stop the bleeding. If a tourniquet is required for an extremity injury, use it only if you have received proper training.
Coagulant powder is another possibility. If you don’t have any, consider cayenne pepper, juniper sap, turmeric, and other natural remedies.
Because you may be miles from help, the most important thing is to stop the bleeding rather than replace the fluids.
The loss of total body water is significant in non-hemorrhagic shock. Because of water loss (rather than blood loss), blood viscosity rises, and thus systemic vascular resistance rises.
Fluid loss can be severe as a result of vomiting and/or diarrhea caused by enteritis from contaminated food or water.
Heat stroke can also cause severe dehydration, which can lead to shock. If heat stroke is not treated promptly, the mortality rate can reach up to 80%. If possible, sit in a cold stream to help cool core temperatures in cases of heat stroke in the wild.
Water loss from burns can also be significant. The evaporation of fluid from the burned area is much greater due to the loss of the skin barrier. The larger the burn area, the more water is lost.
Due to the loss of the protective skin barrier, a burn can also increase the risk of secondary infection. Even in a hospital, someone with a severe burn (third degree) covering more than 40% of their body has a 40% chance of dying.
In a survival scenario, honey would be an excellent makeshift barrier for a burn, acting as both a barrier and a source of antimicrobial protection.
Finally, in a prolonged survival situation, your ability to maintain nutrition and the amount of protein stored in your body both decrease. As protein levels fall, fluid retention in the vascular space becomes more difficult, potentially leading to hypovolemia (a decreased volume of circulating blood in the body).
Cardiogenic shock
This occurs when the heart fails to function properly. When the heart suffers an acute weakness as a result of a heart attack, there is less muscle available to do work.
Because of heart failure, the cardiac muscle can become weak over time and no longer meet the demands of the body.
These circumstances reduce the heart’s ability to pump blood with each contraction, resulting in a decrease in stroke volume.
Another reason the pump cannot meet demand is a slow heart rate. As the heart rate decreases, the heart muscle must contract more forcefully to push the volume of blood out in order to maintain cardiac output.
If the heart rate is too high (more than 200), the heart will not have enough time to fill with blood between the contractions, and the stroke volume decreases. In the hospital, the mortality rate for cardiogenic shock is around 50%.
Normally, aspirin is administered at the onset of a heart attack; however, if aspirin is unavailable, natural salicylates such as blackberries or red raspberries, willow bark, cayenne pepper, and almonds would be used.
A few days of rest would also be beneficial to the patient. It would be unwise to use a drug to increase heart rate. A heart attack most likely affects the pacemaker area of the heart, and putting chemical stress on the heart could increase the area of heart muscle involved.
Obstructive shock
This happens when the heart is compressed and cannot fill with blood. Because the heart cannot exert enough force to contract, the stroke volume decreases.
Tension pneumothorax and pericardial tamponade are two examples. Air leaks from a hole in the lung into the space between the lung and the chest wall in a tension pneumothorax. If the air cannot escape, pressure builds up within the space, causing “tension.”
The increased pressure in the chest prevents the heart from filling and causes blood pressure to fall. The neck veins (jugulars) swell, and the trachea may even deviate away from the injured side. The use of a decompression needle to allow air to escape and reduce tension is a lifesaving measure. In a non-hospital setting, the decompression procedure is far more dangerous.
When fluid accumulates within the pericardial sac surrounding the heart, pericardial tamponade occurs. Because of the constriction and increased pressure in the pericardial space caused by trauma, infection, inflammation, or cancer, this fluid prevents the heart from filling with blood.
This can also result in a drop in blood pressure or symptoms of congestive heart failure.
Natural diuretics such as onions, garlic, grapes, dandelion, and green tea could be used to treat congestive heart failure; however, the likelihood of these being strong enough or acting quickly enough to overcome the effects of pericardial tamponade is very low.
Concluding
Shock is a devastating process with a 50% mortality rate in the hospital setting. The chances of survival are slim in a survival situation without immediate assistance.
Preparing for causes that can be reversed gives you the best chance of survival (e.g. anaphylaxis, hypovolemia, and hemorrhage).
Maintain proper hygiene to prevent even minor scratches from leading to sepsis. Natural plants can be useful in a variety of situations, but they are unlikely to be potent enough or work quickly enough to make a difference in the case of shock.
If you haven’t already, take a basic first-aid course and continue your education to be better prepared for an emergency.
This article has been written by James H. Redford MD for Prepper’s Will.
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